Sir,
As we are already aware, there are a plethora of clinical practice guidelines available for a clinical psychiatrist today. Some of the popular ones include those published by American Psychiatric Society, National Institute of Clinical Excellence, Canadian Network for Mood and Anxiety Treatments, Texas Medical Algorithm Project and Indian Psychiatric Society in our country. A psychiatric clinician is usually bewildered by the choices in front of him, which would be the best choice among the options available?
This is the reason why research on the superiority of one set of guidelines over another becomes imperative. One also needs to be aware of existence of appraisal tools for clinical practice guidelines, which can discern the best from the entire lot. Some common appraisal tools available include Cluzeau instrument, AGREE instrument based on the Cluzeau instrument.[1] Some of the common dimensions considered for evaluation of clinical guidelines are scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, methodological rigour of development, context, content, application and editorial independence. Of all these dimensions, methodological rigour or quality appears to be the single most important factor that decides the quality of clinical care guidelines. A recent systematic review of these appraisal tools mentions Cluzeau as the only tool that has been well-validated and well-accepted.[1]
There are only a few studies that use these appraisal tools to compare various clinical guidelines in psychiatry. These include a British study on depressive guidelines and a study on guidelines for schizophrenia.[2,3] Such studies give invaluable information with regard to the quality of various clinical guidelines available. We cannot afford to ignore this area of research in clinical psychiatry any longer with the advent of evidence-based medicine and proliferation of clinical guidelines with various psychiatric societies coming out with their own guidelines.
REFERENCES
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